Tissue manipulator for use in vitreous surgery combining a fiber optic endoilluminator and membrane pic

ABSTRACT

A surgical instrument for use in penetrating and working in the vitreous humor of an eye comprises a finger grip member and a rigid needle extending from the finger grip member, with a single continuous fiber optic member extending from a distal end of the needle through the needle and the finger grip member to a cone shaped proximal end contained in a large connecting member constructed of heat conductive material. The surgical instrument includes a stripping tool at its distal end that is bent at a right angle and positioned in a plane that is parallel to the longitudinal axis of the needle but does not intersect this axis. The surgical instrument also comprises an infusion/aspiration system including a hollow pipe attached to the needle that extends parallel to the longitudinal axis of the needle but does not interfere with a beam of light projected from the distal end of the fiber optic member extending through the needle. The instrument also includes a coaxial bipolar diathermy comprising an exterior needle surrounding and coaxial to the fiber optic needle, the exterior needle being insulated from the interior fiber optic needle and both needles being electrically connected to a conventional radio frequency generator for creating an electric potential between the distal ends of the interior and exterior needles for use in coagulating bleeding vessels on a retinal surface or beneath pre-retinal membranes.

BACKGROUND OF THE INVENTION

(1) Field of the Invention

The present invention relates to tissue manipulators for use in vitreoussurgery, in particular, a tissue manipulator that combines a fiber opticendoilluminator with a coaxial bipolar diathermy and aninfusion/aspiration system.

(2) Description of the Related Art

Vitreous surgery tissue manipulators of the type provided by the presentinvention commonly comprise a hand-held piece having a hollow needleextending from one end. A plurality of parallel fiber optic membersextend through the hand piece and the hollow needle, and terminate atdistal ends adjacent the distal end of the needle. The proximal end ofthe tissue manipulator hand piece is connected to a light conductingmember that conveys light from an external light source to themanipulator. The light conducting member illuminates the proximal endsof the fiber optic members extending through the tissue manipulator,causing a beam of light to be directed outwardly from the distal ends ofthe fiber optic members adjacent the distal end of the needle.

Because the tissue manipulator needle is used by penetrating the needleinto the vitreous humor of an eye, the external dimensions of the needlemust be kept as small as possible. This, in turn, limits thecross-sectional diameter of the bore through the needle and the numberof fiber optic members extending through the needle bore.

Each of the fiber optic members extending through the manipulator handpiece and needle is surrounded by a non-light conducting cladding. Thecladding directs the light illuminating the proximal ends of the fiberoptic members through the members and out their distal ends. Adisadvantage of this type of conventional tissue manipulator is thatmuch of the cross-sectional area of the fiber optic members extendingthrough the needle bore is taken up by the cladding surrounding each ofthe members and the gap between adjacent members, reducing the actualamount of cross-sectional area of the needle bore that is taken up bythe light conveying optic fibers.

Many conventional tissue manipulators are provided with a membrane picextending from the distal end of the manipulator needle. The pic is usedfor engaging tissues in the vitreous humor of an eye and for retinalmembrane stripping. The pics are commonly formed by grinding down thedistal ends of the manipulator needle until only a narrow portion of theneedle side wall remains. This narrow portion of side wall is then givena general triangular shape, with a section of the narrow side walladjacent the apex of the triangle being bent over at a 45° angle intothe projected path of light from the distal end of the fiber opticmembers extending through the needle.

Because the side walls of the needles are made very thin to devote asmuch of the cross-sectional area available to the fiber optic members, amembrane pic formed in the above-described manner from the thin sidewalls of the needle will tend to bend or break over a period of use.Additionally, because the membrane pic is bent at a 45° angle into theprojected path of light from the distal end of the needle, the lightbeam will often reflect off of the interior surface of the pic and themembrane pic itself will often cast a shadow on the retinal surfaceadjacent the pic, making it difficult for the pic user to observe theend of the pic and the retinal surface adjacent the pic.

Often, in performing vitreous surgery, a separate infusion or aspirationneedle is needed to supply infusion fluid or suction, respectively. Wheninfusion or aspiration is required in vitreous surgery, a third hand foroperating the infusion or aspiration system is also often required.

Moreover, in performing vitreous surgery, it is often necessary tocoagulate bleeding vessels either on a retinal surface or beneathpre-retinal membranes. This situation requires the use of a separatemanual bipolar diathermy instrument to stop the bleeding. When use ofthe diathermy instrument is necessary, an additional hand is oftenrequired to manipulate the instrument.

It is an object of the present invention to overcome the disadvantagesassociated with prior art tissue manipulators by providing a surgicalinstrument for use in vitreous surgery that combines a more efficientfiber optic endoilluminator membrane pic with a coaxial bipolardiathermy or an infusion/aspiration system in a single instrument.

It is a further object of the present invention to provide a fiber opticendoilluminator with an increased illumination capability over the priorart illuminators having the same cross-sectional area.

It is a further object of the present invention to provide a fiber opticlight conveying member that projects an increased amount of illuminationfrom its distal end than prior art fiber optic members having the samecross-sectional diameter at their distal ends due to an improved lightgathering configuration of the proximal end of the fiber optic memberthat is subjected to a source of illumination.

It is also an object of the present invention to provide a tissuemanipulator pic that is stronger than prior art membrane pics and doesnot reflect the beam of light projected from the endoilluminator or castshadows on the retinal surface.

It is a still further object of the present invention to provide aconnector at the proximal end of the light conveying fiber optic memberthat absorbs heat radiated by the source of illumination and conveys theheat away from the proximal end of the fiber optic member.

SUMMARY OF THE INVENTION

The vitreous surgery tissue manipulator of the present invention iscomprised of a hand-held finger-grip member with at least one conduitextending through the member, a hollow manipulator needle secured in theconduit at a distal end of the grip member, and a light conveying fiberoptic member inserted in the conduit at a proximal end of the gripmember. The grip member conduit and a hollow bore extending through theneedle are coaxial and communicate with each other.

A single continuous light conveying fiber optic member extends from asource of light to the tissue manipulator. The fiber optic member isinserted into the grip member conduit at the proximal end of the fingergrip member, and extends through the conduit and the needle bore to itsdistal end. The distal end of the fiber optic member is coplanar withthe distal end of the needle. The single fiber optic member, having agiven cross-sectional diameter, conveys a substantially increased amountof illumination from the source of light to the distal end of the fiberoptic member than do the prior art bundles of fiber optic members havingsubstantially the same cross-sectional diameter.

The fiber optic member of the present invention exits from the proximalend of the tissue manipulator and extends through a protective flexibletube to a connector plug at the proximal end of the fiber optic member.The connector plug is formed from a mass of heat conducting material,such as aluminum or copper, and couples the proximal end of the fiberoptic member to a conventional source of illumination for the tissuemanipulator. The connector receives heat at its proximal end from thesource of illumination and conveys the heat away from the proximal endof the fiber optic member. The heat received is conducted away from thefiber optic member and the source of illumination, and is convected awayfrom the connector plug and illumination source.

The fiber optic member extends through the connector to its proximalend. The proximal end of the fiber optic member and the proximal end ofthe connector are coplanar. A portion of the fiber optic membercontained in the connector is modified into the shape of a truncatedcone. The proximal end of the fiber optic member has an increaseddiameter than the remainder of the member and forms the base of thecone. The cone tapers from its base at the proximal end of the fiberoptic member toward a reduced diameter apex having a diameter equal tothe diameter of the remaining portion of the fiber optic member. Theincreased diameter cone base at the proximal end of the fiber opticmember receives and conveys through the fiber optic member an increasedamount of illumination from the light source than do conventional fiberoptic members having a substantially constant diameter along theirentire lengths.

In one embodiment of the invention, the continuous cross-sectionaldiameter of the fiber optic member between its proximal and distal endsis less than the cross-sectional diameter of the finger grip memberconduit and the cross-sectional diameter of the needle bore throughwhich it extends. The difference in cross-sectional diameters creates anopen passage running parallel with the fiber optic member through thetissue manipulator grip member and needle.

A proximal end of the open passage adjacent the proximal end of thetissue manipulator is adapted to be connected with a selectivelysupplied external source of fluid or suction such as a saline solutionor a visco-elastic liquid, or a conventional aspiration system,respectively. This structure permits the selective supply of a liquid orsuction through the open passage formed through the finger grip memberand manipulator needle to the distal end of the needle. The fluiddispensed from the distal end of the needle can be used to movemembranes or flush blood and debris and other tissues from the retinalsurface where vitreous surgery is taking place. The suction provided atthe distal end of the needle can be used to aspirate membranes, tissuesand other debris into the needle distal end.

In a similar embodiment to the one described above, a rigid tube havingthree sections is attached to the exterior surface of the manipulatorneedle. A main section of the tube runs parallel with the manipulatorneedle and terminates in a bent section that extends a slight distancefrom the distal end of the needle. The bent section of the tube extendsfrom the main section at an angle of 45° to the longitudinal axis of theneedle, and does not protrude into the direct path of a beam of lightprojected from the distal end of the fiber optic member and the distalend of the needle. The opposite end of the main tube section is alsoconnected to a bent section that extends outward at an angle of about45° from the axis of the needle and the finger grip member. This end ofthe rigid tube is adapted to be connected with an exterior source ofselectively supplied fluid or aspiration. On selective supply ofpressurized fluid to this end of the rigid tube, the fluid is conveyedthrough the tube and is dispensed from the bent section of the tubeadjacent the distal end of the needle. Again, the pressurized fluidconveyed through the tube can be used in moving tissues or membranes, orlocalized flushing of blood and debris from the retinal surface wherevitreous surgery is taking place. The suction selectively provided atthe distal end of the bent section of the tube can be used to aspiratemembranes, tissues and other debris into the tube.

The distal end of the needle may also be provided with a pic thatextends a slight distance beyond the distal end of the needle. The picis formed from a rigid wire connected to the exterior surface of theneedle. The wire extends parallel to the needle a slight distance beyondthe distal end of the needle, and is bent at a right angle at its distalend. The bend in the distal end of the wire is oriented so that it willnot protrude into the direct path of a beam of light projected from thedistal end of the fiber optic member at the distal end of the needle.The positioning of the wire and the diameter of the wire being smallerthan the diameter of the light conducting fiber optic member eliminatesthe pic reflection and shadow problems encountered with conventionaltissue membrane pics, while still permitting a small amount of indirectlight projected from the fiber optic member to illuminate the wire picdistal end, enabling the user of the pic to see the pic in the vitreoushumor of an eye.

In addition, the cross-section of the bent distal end of the wire pic isshaped as an ellipse, with the major axis of the ellipse extendingparallel to the longitudinal axis of the tissue manipulator grip memberand needle. Providing the distal end of the wire pic with an ellipticalcross-section improves the usefulness of the membrane pic in retinalmembrane stripping. Moreover, by forming the membrane pic from aseparate piece of rigid wire, the strength of the pic is substantiallyincreased over conventional membrane pics formed by grinding down andbending over a side wall of the tissue manipulator needle.

A further embodiment of the present invention includes a tissuemanipulator comprising a coaxial bipolar diathermy system. Thismanipulator comprises a hollow needle with a fiber optic memberextending through its length as in the embodiments described above, andalso includes an exterior metal tube coaxial to and surrounding themanipulator needle. The exterior tube is separated from the interiormanipulator needle by an insulating material that completely surroundsthe exterior surface of the interior needle. The needle and the exteriortube are electrically connected to a radio frequency generator and areselectively subjected to electric charges of different polarities,creating an electrical potential between the distal end of the needleand the distal end of the exterior tube. The potential created at thedistal end of the needle and tube is used in diathermy coagulation ofbleeding vessels either on the retinal surface or beneath pre-retinalmembranes.

BRIEF DESCRIPTION OF THE DRAWINGS

Further objects and features of the present invention are revealed inthe following detailed description of the preferred embodiments of theinvention and in the drawing figures wherein:

FIG. 1 is a segmented perspective view of the vitreous surgery tissuemanipulator of the present invention;

FIG. 2 is a side elevation view in section of the finger grip portionand needle portion of the tissue manipulator of the present invention;

FIG. 3 is a segmented perspective view of the details of the strippingpic and distal end of the tissue manipulator needle;

FIG. 4 is a segmented perspective view of the details of the strippingpic at the needle distal end;

FIG. 5 is a side view in section of the light source connector at theproximal end of the tissue manipulator of the present invention;

FIG. 6 is a side view in section of another light source connector atthe proximal end of the tissue manipulator of the present invention;

FIG. 7 is a segmented perspective view of the component parts of thetissue manipulator of the present invention comprising a coaxial bipolardiathermy;

FIG. 8 is a segmented view in section of the coaxial bipolar diathermytaken along the line 8-8 of FIG. 7;

FIG. 9 is a view in section of the light source connector at theproximal end of the tissue manipulator taken along the line 9--9 of FIG.7;

FIG. 10 is a segmented perspective view of the tissue manipulator of thepresent invention provided with an infusion/aspiration tube;

FIG. 11 is a view in section of the detail of the proximal end of thetissue manipulator of FIG. 10 taken along the line 11--11 of FIG. 10;

FIG. 12 is an end view in section of the tissue manipulator of FIG. 10taken along the line 12--12 of FIG. 10;

FIG. 13 is a side view in section of the tissue manipulator of FIG. 10taken along the line 13--13 of FIG. 12;

FIG. 14 is a plan view in section of the tissue manipulator of thepresent invention with in infusion passage passing through themanipulator;

FIG. 15 is a cross-section view of the tissue manipulator of FIG. 14taken along the line 15--15 of FIG. 14;

FIG. 16 is a cross-section view of the tissue manipulator of FIG. 14taken along the line 16--16 of FIG. 14; and

FIG. 17 is a cross-section view of the tissue manipulator of FIG. 14taken along the line 17--17 of FIG. 14.

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENT

FIG. 1 shows the component parts of the vitreous surgery tissuemanipulator of the present invention. The tissue manipulator includes aneedle portion 20, a finger grip member 22, a flexible fiber opticconnection 24, and an illumination source connecting member 26.

A cross-sectional view of the general structure of the needle portion 20and finger grip portion 22 of the tissue manipulator is shown in FIG. 2.The finger grip portion 22 is generally cylindrical and is formed with aseries of serrations 28 formed around the exterior of the member thatfacilitate the gripping and manipulating of the member. A hollow conduit30 extends through the grip portion 22 between its proximal 32 anddistal 34 ends. The flexible fiber optic connection 24 is inserted intothe conduit 30 at the proximal end 32 of the grip portion. The needleportion 20 is inserted into the conduit 30 at the distal end 34 of thegrip portion.

As seen in FIG. 2, the flexible fiber optic connection 24 is comprisedof a continuous single fiber optic member 36 surrounded by a flexible,protective, insulation 38. The conduit 30 is counterbored so that it hastwo different internal diameters that meet at an abutment 39, the largerdiameter being sized to receive the fiber optic member and itssurrounding insulation. The insulation 38 of the fiber optic connection24 terminates at a distal end 40 intermediate the grip portion conduit30 at the abutment 39 where the larger diameter counterbore ends and thesmaller diameter portion of the conduit 30 begins. The proximal end ofthe connection 24 terminates intermediate a connector plug to bedescribed later.

The needle portion 20 is comprised of a hollow tubular stainless steelneedle 42 inserted into the conduit 30 at the distal end 34 of thefinger grip portion 22. The needle 42 terminates at a proximal end 44intermediate the smaller diameter portion of the conduit 30, spaced fromthe distal end 40 of the fiber optic insulation 38. The fiber opticmember 36 contained within the insulation 38 extends beyond the distalend 40 of the insulation, through the reduced diameter portion of theconduit 30 to the needle proximal end 44, and through the interior boreof the needle 42. The distal end 46 of the fiber optic member 36terminates at the distal end 48 of the needle 42.

A membrane stripping tool or pic 50 is also provided at the distal end48 of the needle. The pic 50 is constructed of a rigid wire that ispreferably bent at a right angle between a proximal section 52 and adistal section 54. The wire sections may be bent at a different angle ifdesired. The proximal section 52 of the wire is secured to the exteriorsurface of the needle adjacent the distal end 48 and parallel to thelongitudinal axis of the needle The proximal end 52 of the strippingtool can be secured to the exterior surface of the needle 42 by welding,brazing or some other equivalent means. The wire and the weld betweenthe wire and the needle exterior surface are machined to present asmooth surface at the join between the wire and needle surface. Thedistal end 54 of the tool 50 is bent at a right angle and is positionedrelative to the distal end 46 of the fiber optic member 36 so that itwill not extend into a projected path of light from the distal end 46 ofthe fiber optic member.

As seen in FIGS. 3 and 4, the proximal and distal ends 52, 54 of thestripping tool 50 are bent at a right angle and are positioned in aplane that is parallel to the longitudinal axis of the needle 42 andspaced slightly above this axis. This positioning of the stripping tool50 prevents the direct light projected from the distal end 46 of thefiber optic member 36 from reflecting back off of the distal end 54 ofthe stripping tool, and prevents the distal end 54 of the stripping toolfrom casting a shadow on the retinal surface illuminated by a beam oflight projected from the distal end 46 of the fiber optic member 36.Some of the indirect light projected from the distal end of the fiberoptic member illuminates the distal end of the tool to enable the tooluser to see the tool in the vitreous humor of an eye. Any reflection ofthe indirect light does not interfere with the vision of the user andany shadow of the tool will not be in the area of the work beingperformed with the tool.

The distal end 54 of the stripping tool 50 is also worked so that itscross-section is in the form of an ellipse, with the minor axis of theellipse being parallel to the longitudinal axis of the needle 42. Theellipse minor axis is also contained in a plane containing the proximalsection 52 and distal section 54 of the stripping tool. The ellipticalcross-section of the distal end 54 of the stripping tool 50 enhances itsusefulness in removing tissues from the retinal surface of an eye.

At the proximal end of the flexible fiber optic connection 24 is theillumination source connector 26. The connector includes a plug 60 thatis formed from a large amount of material having a high thermalconductivity. The larger size of the plug enhances its ability toconduct heat from an illumination source away from the fiber opticmember contained in the plug. The exterior of the plug 60 is formed astwo generally cylindrical sections with different diameters.

A first section 62 of the plug exterior has the larger diameter and isformed with a slight recess 64 in the circumference of the exteriorsurface. The recess 64 is provided to be gripped by an instrumentoperator to facilitate the insertion and removal of the connector plug60 from a source of illumination.

The reduced diameter section 66 of the plug connector 60 is dimensionedto be inserted into an access opening of a conventional source ofillumination to subject the proximal end 68 of the fiber optic member 36to the source of illumination. The smaller plug section 66 is alsoprovided with a recess 70 around its exterior surface to facilitate inthe connection between the plug and the illumination source into whichit is inserted.

The connector plug 60 includes a conduit 72 extending through the plugbetween its distal 74 and proximal 76 ends. The proximal end of thefiber optic member 36 and its surrounding protective insulation 38 areinserted into the conduit 72 at the distal end 74 of the plug. Theflexible insulation 38 of the fiber optic member 36 terminates at aproximal end 78 intermediate the conduit 72 of the plug. The fiber opticmember 36 extends completely through the conduit 72 of the plug to theproximal end 68 of the fiber optic member, coplanar with the proximalend 76 of the plug.

A portion of the fiber optic member 36 adjacent its proximal end 68 isformed in the shape of a truncated cone 80. In the preferred embodiment,the length of the truncated cone 80 is 0.200 of an inch long, with thediameter of the cone base 68 being 0.040 of an inch and the diameter ofthe cone apex 82 being 0.030 of an inch. The diameter of the cone apexis substantially the same diameter as the continuous fiber optic member36 extending between the cone apex 82 and the distal end 46 of the fiberoptic member.

The cone shape 80 provided at the proximal end of the fiber optic member36 enhances the ability of the proximal end 68 of the fiber optic memberto absorb light from the source of illumination into which the plugconnector 60 is inserted. For cone sections of different lengths, it isfound that forming the base of the cone by increasing the radius of thefiber optic member distal end by 0.025 times the length of the conegives the most beneficial results.

The connector plug 60 itself is formed from a substantial amount of ahigh heat conducting material such as aluminum. The increased mass ofthe connector plug 60 enhances its ability to convey heat radiated fromthe source of illumination, away from the fiber optic member 36 and thesource of illumination. The smaller section, 66 of the plug is insertedinto an access opening of the source of illumination and absorbs heatradiated and convected by the source of illumination. The heat absorbedby the small plug section 66 is conducted through the connector plugaway from the fiber optic member 36 and toward the large plug section62. Heat conducted to the large plug section 62 is then convected awayfrom the connector plug 60 outside the source of illumination. In thismanner the fiber optic member 36 and its insulation 38 are protectedfrom the heat radiated and convected from an intense source ofillumination.

FIG. 6 shows another embodiment of the connector plug 84 for connectingthe proximal end 68 of the flexible fiber optic connection 24 of thepresent invention to a conventional source of illumination. As can beseen from the drawing figure, the relationship between the proximal endof the fiber optic connection 24 and the connector 84 is substantiallythe same as that disclosed with reference to FIG. 5.

In FIG. 6, the flexible fiber optic connection 24 is inserted into aconduit 86 extending through the connector 84 at a distal end 88 of theconnector. The flexible insulation 38 of the fiber optic connection 24terminates at its proximal end 78 intermediate the plug conduit 86. Theproximal end 68 of the fiber optic member 36 ends coplanar with theproximal end 90 of the plug 84. Here, the fiber optic member 36 adjacentits proximal end is again formed as a truncated cone section 80. Thebase of the cone is coplanar with the proximal end 68 of the fiber opticmember 36 and the proximal end 90 of the connector 84, and the apex 82of the cone has the same diameter as the continuous length of the fiberoptic member 36 extending from the cone apex 82 to the distal end of thefiber optic member 46. A short length of silicone rubber tubing 91surrounds the cone section of the fiber optic member and is press-fitinto a counterbored portion of the conduit 86 adjacent the proximal end90 of the plug. The silicone tubing 91 holds the cone section of thefiber optic member in the plug conduit. This type of connector may beused where it is not necessary to conduct heat from an intense source ofillumination away from the fiber optic member.

FIG. 7 shows an embodiment of the present invention that incorporates acoaxial bipolar diathermy into the structure of the tissue manipulatorof the present invention. This embodiment comprises a needle portion 92,a finger grip portion 94, a flexible fiber optic connection 96, aflexible radio frequency generator connection 98, and a length offlexible junction tubing 100.

This embodiment of the invention is similar to the previously describedembodiment in that it comprises a continuous single fiber optic memberextending through the entire length of the instrument. This embodimentmay also comprise a stripping tool or pic 102 identical to thepreviously described stripping tool 50 at the distal end of theinstrument. The stripping tool may be left off of the needle portion 92if only the diathermy feature is desired.

The finger grip portion 94 of the tissue manipulator of FIG. 7 has agenerally cylindrical configuration with a series of serrations 104extending around the circumference of the grip portion to facilitate inthe handling of the instrument. The grip portion 94 also has a conduit106 extending through its interior between a distal end 108 of the gripportion and a proximal end 110 of the grip portion. The needle portion92 is inserted into the conduit 106 at the distal end 108 of the gripportion and is held securely in the conduit by a separate plug 112surrounding the needle portion and press-fit into the conduit 106. Adistal end 114 of the flexible junction tubing 100 is inserted into andsecurely held in the conduit 106 of the grip portion 94 at the proximalend 110 of the portion.

The structure of the needle portion 92 of this embodiment is shown inFIG. 8 of the drawings. The needle portion is comprised of a hollowinterior needle 120 having a proximal end 122 held securely within theconduit 106 of the grip portion 94. The interior needle extends out ofthe distal end 108 of the grip portion, coaxial with the longitudinalaxis of the grip portion, to a distal end 124.

As in the previously described embodiment, the fiber optic member 126extends through the interior bore 128 of the interior needle 120 to itsdistal end 130 that is generally coplanar with the distal end 124 of theinterior needle. The entire exterior surface of the interior needle 120is covered with an insulating material 132, such as a polyamide resin,except for a portion of the exterior surface adjacent the proximal end122 of the needle 120.

Completely surrounding the interior needle 120 and separated from theinterior needle by the insulating material 132 is an exterior needle134. The insulating material 132 prevents contact between the coaxialinterior needle 120 and exterior needle 134. A proximal end 136 of theexterior needle 134 is held securely in the conduit 106 of the gripportion 94 by the plug 112. The exterior needle extends from the distalend 108 of the grip portion, coaxially with the interior needle 120 andthe fiber optic member 126, to a distal end 138 located adjacent thedistal end 124 of the interior needle 120 and the distal end 130 of thefiber optic member 126. The distal ends of the exterior needle 134 andthe interior needle 120 are slightly rounded and therefore are not trulycoplanar with the distal end 130 of the fiber optic member 126.

As in the previously described embodiment, a proximal end 140 of a pic102 may be secured to the exterior surface of the exterior needle 134parallel to the longitudinal axis of the needle portion 92. Thestripping tool is bent at a right angle at its distal end 142.

Within the conduit 106 of the grip portion 94, the proximal end 122 ofthe interior needle 120 is electrically connected to an electricalconductor 142. The electrical conductor 142 is covered with aninsulation 144 adjacent its connection to the interior needle 120, andthe insulated conductor 142,144 extends out of the proximal end 110 ofthe grip portion 94, through the flexible junction tubing 100 and theflexible RF generator connection 98 to a banana plug 146 at the proximalend of the insulated electrical conductor 142,144.

A second electrical conductor 148 is electrically connected to theproximal end 136 of the exterior needle 134. This electrical conductoris also covered with an insulation 150 adjacent its connection to theproximal end 136 of the exterior needle. The insulated second conductor148,150 extends through the conduit 106 of the grip portion and out theproximal end 110 of the grip portion, through the flexible junctiontubing 100 and the flexible RF generator connection 98, to a secondbanana plug 152 at the proximal end of the insulated conductor 148,150.

The two banana plugs 146, 152 are provided to be inserted into outputjacks of a conventional radio frequency generator. With an RF generatorconnected to the banana plugs, the generator can be selectively operatedto supply electrical charges of different polarities to the twoelectrical conductors 148, 142. The electrical charges supplied to theelectrical conductors are conveyed through the conductors to theexterior needle 134 and the interior needle 120, respectively. Bysubjecting the exterior and interior needles to electrical charges ofdifferent polarities, an electrical potential is created between thedistal ends of the exterior needle 134 and the interior needle 120,providing a coaxial bipolar diathermy at the distal end of the needleportion 92 of the instrument for use in coagulating bleeding vessels oneither the retinal surface or beneath pre-retinal membranes.

As in the first described embodiment, the fiber optic member 126 is asingle continuous fiber that extends from its distal end 130 at thedistal end of the needle portion 92, through the finger grip member 94,the flexible junction tubing 100, and the flexible fiber opticconnection 96 to the connector plug 154 at its proximal end 156. Thefiber optic member 126 is secured in the connector plug 154 by a shortlength of silicone rubber tubing 158 adjacent its distal end.

The connector plug 154 shown in FIG. 9 is another variation of theillumination source connector that can be employed with the presentinvention. The exterior surface of the plug is shaped to be insertedinto an illumination source connection having a complementary shape.

Again, as in the first embodiment, a portion of the fiber optic member126 adjacent its proximal end 156 is shaped in the form of a truncatedcone 160 having a base coplanar with the proximal end 156 of the fiberoptic member. The cone apex 162 has a diameter equivalent to thediameter of the remaining portion of the fiber optic member 126extending between the apex 162 and the distal end 130 of the member. Thesilicone tubing 158 holds the cone section of the fiber optic member inthe conduit of the plug 154. By subjecting the base 156 of the cone 160at the proximal end of the fiber optic member 126 to the source ofillumination, the fiber optic member 126 gathers and conveysillumination through its length to its distal end 130 where it projectsa beam of light parallel to the longitudinal axis of the needle portion92 of the instrument.

FIG. 10 shows an embodiment of the invention comprising aninfusion/aspiration system. The tissue manipulator of this embodiment ofthe invention is substantially identical to the tissue manipulator ofFIGS. 1 and 2, except that it is not shown as comprising a strippingtool at its distal end. The tissue manipulator of FIG. 10 comprises aneedle portion 170, a finger grip portion 172, and a flexible fiberoptic connection 174 extending to an illumination source connector (notshown). The structures of these components are identical to thosedescribed with reference to the first embodiment of the invention shownin FIGS. 1 and 2.

Attached to an exterior surface of the needle 176 is aninfusion/aspiration assembly. The assembly includes a three-sectionhollow pipe 178 having an intermediate section 180 secured to the needle176 parallel to the longitudinal axis of the needle portion and fingergrip portion. The intermediate section 180 of the pipe extends a smalldistance past the distal end 182 of the needle 176 to a distal section184 of the pipe. The distal section 184 of the pipe is angled at about45° from the longitudinal axis of the intermediate section 180 of thepipe. Both the distal section 184 and the intermediate section 180 ofthe pipe are positioned in a plane that runs parallel to thelongitudinal axis of the needle portion 170 of the instrument but doesnot intersect this axis.

A proximal section 186 of the pipe is connected to the intermediatesection 180 opposite to its connection to the distal section 184. Theproximal section 186 extends off from the intermediate section 180 at anangle of 45° to the longitudinal axis of the intermediate section. Theproximal section 186 is surrounded by an adapter sleeve 188 that, inturn, is inserted into a length of flexible tubing 190. The flexibletubing 190 is secured in a seal-tight connection to the adapter sleeve188 by a connector band 192 securely fastened around the flexible tubing190, the adapter sleeve 188, and the proximal end 186 of the pipe.

The opposite end of the flexible tubing 190 is connected with an adapterassembly 194 that is dimensioned to be connected with a conventionalinfusion or aspiration source. By selectively supplying fluid underpressure to the adapter assembly 194, the fluid is conveyed through theflexible tubing 190 to the center bore 196 of the proximal pipe section186. The fluid passes through the proximal section bore 196 to theintermediate section bore 198, and through the intermediate section bore198 to the distal section bore from which it is dispensed from theinfusion/aspiration three-section pipe 178. The three section pipe canalso be connected to a source of suction to provide aspiration at thedistal section of the pipe.

This embodiment of the present invention provides a means of supplyingfluid or a suction at the distal end of the instrument withoutobstructing the beam of light projected from the distal end 202 of thefiber optic member 204 extending through the instrument.

FIGS. 14-17 show a still further embodiment of the present inventioncomprising an infusion/aspiration system. This embodiment includes aneedle portion 206, a finger grip portion 208, and a flexible fiberoptic connection 210. The finger grip portion 208 of this embodiment iscomprised of a front 212 and back 214 section. The front section 212 ofthe grip portion has a generally cylindrical exterior surface and aninterior conduit extending through the section between its proximal end216 and its distal end 218.

The interior conduit of the front section 212 is comprised of threecylindrical chambers. A first chamber 220 of the interior conduit ispositioned adjacent the proximal end 216 of the front section and hasthe largest interior diameter of the three chambers. The second chamber222 is positioned adjacent the distal end 218 of the front section andhas a diameter large enough to receive the proximal end 224 of theneedle 226 and hold the needle securely in place extending from thedistal end 218 of the front section. The third chamber 228 of theinterior conduit is positioned intermediate the first and secondchambers and has an interior diameter intermediate the diameters of thefirst and second chambers.

The back section 214 of the grip portion of the instrument also has agenerally cylindrical exterior surface with a portion 230 of the backsection 214 adjacent the distal end 232 of the back section having areduced outside diameter. The reduced diameter portion 230 of the backsection 214 is inserted into and secured in place in the first chamber220 of the front section 212. The back section 214 also has first andsecond conduits 234,236 extending through its length between the distalend 232 of the section and the proximal end 238 of the section.

A tubular adapter 240 is inserted into the first conduit 234 at theproximal end 238 of the back section 214. A flexible tube 241 of aconventional infusion/aspiration system is connected with the tubularadapter 240 establishing fluid communication between theinfusion/aspiration system and the first chamber 220 of the grip portion208.

The second conduit 236 is coaxial to the finger grip portion 208 and theneedle portion 206 of the instrument. A flexible fiber optic connection210 of the type described with reference to the first embodiment isinserted in the second conduit 236 at the proximal end 238 of the backsection 214. The diameter of the second conduit is dimensioned largeenough to securely receive the distal end 242 of the insulating tubing244, surrounding the fiber optic member 246 of the flexible fiber opticconnection 210. The fiber optic member 246 extends beyond the distal end242 of the insulating tubing and through a tubular sleeve 247 that ispress-fit into the second conduit 236 at the distal end 232 of the backsection 214. The sleeve forms a fluid seal between the fiber opticmember 246 and the second conduit 236. The fiber optic member extendsfrom the sleeve 247 through the first chamber 220, the third chamber228, and the second chamber 222 of the front section of the grip member208, and through the interior bore 248 of the needle 226 of theinstrument needle portion 206. The distal end 250 of the fiber opticmember 246 terminates coplanar with the distal end of the needle 226.

As best seen in FIG. 17, the outside diameter of the fiber optic member246 is slightly smaller than the interior diameter of the needle bore248. This difference in the diameters of the fiber optic member and theneedle interior bore creates an open passage 252 extending along thelength of the interior bore of the needle and the exterior surface ofthe fiber optic member contained within the bore of the needle.

By selectively supplying either pressurized fluid or suction to theflexible tubing 242 from a conventional infusion/aspiration system, thefluid or suction is transmitted through the tubular adapter 240, thefirst conduit 234, the first chamber 220, the third chamber 228, thesecond chamber 222, and the open passage 252 between the interior bore248 of the needle 226 and the exterior surface of the fiber optic member246 to the distal end 250 of the needle portion 206 of the instrument.

With this assembly, fluid infusion or aspiration is provided at thedistal end 250 of the needle portion of the instrument in addition tothe illumination supplied at the distal 250 of the needle provided bythe fiber optic member 236 proximal end being selectively illuminated bya source of light.

Although the component parts of the present invention have beendescribed above by reference to specific embodiments of the inventionemploying two or more of the component parts of the invention, it shouldbe understood that these embodiments are only illustrative and thatmodifications and variations of the invention that comprise one or allof the component parts of the invention described above may beconstructed without departing from the scope of the invention defined inthe following claims:

What is claimed is:
 1. A fiber optic endoilluminator surgical instrumentfor projecting illuminating light into the vitreous humor of an eye,comprising:a finger grip member having a first end and a second end; anelongated passageway through said finger grip member from said first endto said second end; a hollow rigid needle adapted to penetrate into thevitreous humor of an eye, said needle extending from said first end ofsaid grip member; a flexible tube extending from said second end of saidgrip member; a fiber optic means in said tube and said needle fortransmitting illuminating light from an illuminating light sourcethrough said flexible tube and said needle and for providingilluminating light into the vitreous humor of an eye; a stripping toolconnected to said needle and protruding from said needle along a linethat does not intersect a beam of light projected from said fiber opticmember when said fiber optic member is illuminated by a source ofillumination; and said stripping tool being a rigid wire bent at anangle at a distal end of the wire from its connection to the needle, thewire being positioned in a plane that does not intersect a beam of lightprojected from said fiber optic means when said fiber optic means isilluminated by a source of illumination.
 2. A fiber opticendoilluminator surgical instrument for projecting illuminating lightinto the vitreous humor of an eye, comprising:a finger grip memberhaving a first end and a second end; an elongated passageway throughsaid finger grip member from said first end to said second end; a hollowrigid needle adapted to penetrate into the vitreous humor of an eye,said needle extending from said first end of said grip member; aflexible tube extending from said second end of said grip member; afiber optic means in said tube and said needle for transmittingilluminating light from an illuminating light source through saidflexible tube and said needle and for providing illuminating light intothe vitreous humor of an eye; a stripping tool connected to said needleand protruding from said needle along a line that does not intersect abeam of light projected from said fiber optic member when said fiberoptic member is illuminated by a source of illumination; and saidstripping tool being a rigid wire having an elliptical cross-sectionwith a minor axis that is positioned in a plane that does not intersecta beam of light projected from said fiber optic means when said fiberoptic means is illuminated by a source of illumination.
 3. A surgicalinstrument for use in penetrating and working in the vitreous humor ofan eye, the instrument comprising:a finger grip member having first andsecond ends, with a passageway extending through the grip member betweenthe first and second ends; a needle extending from the first end of thegrip member; and a pic member extending from a distal end of the needle,the pic being bent at an angle and being position in a plane that isparallel to and is not intersected by the needle.
 4. The surgicalinstrument of claim 3 comprising:the needle having a bore through itscenter, the bore being coaxial to and communicating with the passagewayof the grip member, and a single fiber optic member extending throughthe passageway and the needle bore and terminating adjacent the distalend of the needle.
 5. The surgical instrument of claim 3 comprising:thepic member being a rigid wire having a proximal end connected to andparallel with the needle, and having a distal end bent at a right angleto the proximal end.